| NPI | 1912308511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL BCBA1-22-60126) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT20116305) |
| 224Z00000X Occupational Therapy Assistant (Licence: FL OTA13870) | |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2022-08-19 |